Tuberculosis: reasons for diagnostic delay in Auckland

Aims. First, to quantify the interval between the onset of symptoms and the start of anti-tuberculous treatment in a series of Auckland tuberculosis p atients. Second, to examine the help-seeking behaviour of the patients and the responses of the health-care providers whom they consulted about their symptoms. Third, to identify potentially modifiable reasons for delayed pre sentation or diagnosis. Methods. 100 patients with tuberculosis (TB) were interviewed using a quest ionnaire which sought symptom duration and help-seeking behaviour. The doct ors whom they consulted were surveyed about their diagnostic, therapeutic a nd referral responses. Results. Delayed presentation by patients ('patient delay') was found in sm okers, patients who reported cough, patients who hoped their symptoms would go away on their own, and patients reporting fear of what would be found o n diagnosis. 'Doctor delay' (the interval from first consultation with a do ctor to start of treatment) was longer than that found in most published se ries and was a more important component of total delay than delayed present ation by patients. Longer doctor delay was found if patients had pre-existi ng lung disease or consulted multiple doctors, and if doctors did not inqui re into past exposure to TB or request a chest X-ray. Conclusions. Awareness programmes for high-risk communities are needed to e ncourage early reporting of symptoms. Continuing medical education for gene ral practitioners is needed to encourage vigilance for TB and earlier use o f diagnostic tests in patients who have symptoms of TB and are in high-risk groups.